November 20, 2009

Can't Get A Flu Shot? Don't Blame Obama

Conservatives have been quick to blame the administration for the slow delivery of H1N1 vaccine. Not long after Obama declared the swine flu pandemic a national emergency last month--a measure that cleared the way for hospitals to make special preparations for infected patients--Missouri Representative Roy Blunt pounced on the administration’s “onerous regulatory and legal environment” as a cause for the vaccine delays. In the Weekly Standard last week, Bill Kristol held up the swine flu response as an example of the coming “big government health care” boondoggle. “Surely this spectacle, happening in real time before us, will give even more Democrats pause. Do they really want to be known as the Swine Flu Democrats?” Earlier this month, Rush Limbaugh declared that the problem was on par with the Bush administration’s disastrous federal response to Hurricane Katrina.

But how much blame should the government really get for the shortage? Late last month, Sheryl Gay Stolberg reported on the administration’s efforts to respond to the threat of a pandemic. From the start, she reported, Obama seemed determined to put forth a coordinated plan for dealing with the outbreak, studying past government responses to flu epidemics with the help of former administration officials and adding swine flu updates to his regular intelligence briefings. The administration created a government website and public service campaign to inform the public of precautionary measures they could take to avoid the flu. And, most importantly, they moved swiftly to contract with a roster of vaccine manufacturers and got the first doses out to high-risk patients earlier than every country but Australia and China. “[T]he Obama administration left little to chance,” she notes.

One thing they didn’t fully appreciate, however, was the inherent unpredictability of the vaccine manufacturing process. Flu vaccines are typically prepared by injecting the virus into fertilized chicken eggs and incubating them until they become infected. The egg fluid is then harvested and mixed with an embalming fluid, which prevents the virus from causing illness but triggers a response from the immune system that will prevent a future infection. As Allison Bond explained in Discover, there is ample opportunity for the process to become complicated if the egg rots, or the virus grows slowly or produce a weak vaccine. (As Bond notes, HHS devoted $1 billion in funds to develop new vaccine-making technology in 2006, but those technologies weren’t ready for use when H1N1 started spreading earlier this year.)

Vaccine manufacturers were already producing the seasonal flu vaccine earlier this year when public health officials asked them to begin work on producing a swine flu vaccine. Manufacturers have limited access to fertilized chicken eggs, and some had to be diverted to produce an H1N1 vaccine, causing delays for the seasonal doses. In the eggs they had, the virus grew more slowly than expected, and the serum produced was less potent than expected, although they weren’t aware of that until researchers created a test for the vaccine’s potency in August. Projections of available doses dwindled over time—from July, when manufacturers and public health officials expected 120 million doses to be ready by the end of October, to about 40 million. According to the CDC, just over 40 million doses have shipped as of today.

If the administration deserves criticism, critics mostly agree, it’s for reporting the vaccine manufacturer’s optimistic predictions about when the doses would be available. Then again, as others have noted, manufacturers had to slow down the process because the government wanted the vaccine produced in single-dose vials--and that was because consumers feared that a chemical used in multi-dose vials might cause autism. It’s indicative of the delicate balancing act the administration has been trying to perform, between responding quickly with a vaccine and making sure the product they put forward was safe for public use. The problem the delay poses now, as the vaccine becomes more readily available, is that it’s possible that as many as 63 percent of Americans could be infected by the end of the year, according to one prediction, making much of the pre-ordered vaccine seem worthless to vaccine skeptics. There’s mounting evidence that the majority of Americans won’t get vaccinated anyway. More on that soon.